Treatment of pulmonary metastases of initial stage I hepatoblastoma in childhood. Report from the Childrens Cancer Group.

BACKGROUND

Hepatoblastoma is a difficult tumor to treat if not completely resected. Historically, the outlook has been dismal in children in whom recurrent disease has developed. To determine better treatments for recurrent hepatoblastoma, the experience of a recent Childrens Cancer Group study was reviewed.

METHODS

Data were reviewed for all children with localized (Stage I) hepatoblastoma enrolled in the Childrens Cancer Group protocol CCG-881. Particular attention was paid to children with recurrent disease that included the lungs. Initial pathology slides, retreatments offered these patients, and patient survival were reviewed.

RESULTS

In an initial group of 33 children with Stage I hepatoblastoma, there were 10 in whom recurrent disease developed. Six of these had pulmonary metastasis develop with or without other sites of recurrence. One of these six children had a very good partial response to retreatment with combination chemotherapy, but, overall, the most effective treatment modality was surgical resection of the pulmonary disease. Three children (of a total of 10 patients who had a recurrence at any site and 6 who had a recurrence that included the lung) are long-term disease-free survivors 64-104+ months after their most recent recurrence.

CONCLUSIONS

Extended disease-free survival is possible for children with recurrent hepatoblastoma if the recurrence is isolated to the lung and an aggressive surgical approach with intent to cure is used.